The high rate of chloroquine resistant malaria in Papua New Guinea has resulted in a change in the health department’s policy on malaria treatment. The first line treatment used to be chloroquine plus Fansidar but it is no longer. The new first line treatment is lumefantrine (I think, need to confirm). An artemisinin based combination therapy. I am not sure if Fansidar is will be used or not.
I have had a difficult time trying to obtain the document outlining this new health department malaria treatment protocol.
I was told the new treatment protocol was changed two years ago but the health department has not bought the drugs yet. However, the training for the new treatment has already begun. Some health workers had training last year and some are having their training this month. What I find frustrating is that changes in standard treatment protocols is slow in reaching the rural heath posts and district hospitals in PNG. First of all, I think all medical doctors in PNG should have a copy of any new health department treatment protocols as soon as it is approved for use in hospitals and health centres. The department should have a data base of all doctors in PNG and know where exactly they are and if they are moving they should be able to know where they are working next. Regardless of whether they are working in the public system of in private industries. By disseminating information such as new treatment protocols in a timely manner means treatment is standardised as soon as changes occur. Furthermore, all documents such as the health plan or treatment protocols should be kept on the department website and must be easily downloadable. The department must move with technology and take advantage of advances in ICT.
I have now been referred to the provincial health office to obtain a copy of the new malaria treatment protocol. Shouldn’t the health department also issue copies to all hospital doctors and district hospital based medical doctors too? I must say I am quite disappointed!
A few posts ago I wrote about the National Health Plan. A few of my readers wanted an electronic copy but there was not any. Of if there was, we do not know where to obtain one. Again the first place to check would be the health department website. Is is there? Someone can notify me when it is there for download.
Thanks to my friends at WHO office in Port Moresby, I receive updates as wells new treatment protocols from WHO on HIV treatment and policy from their Port Moresby office via email. You might be interested in the new estimation data for PNG on HIV and AIDS. You can download it below:
PNG Data from new estimation report 2010
Unfortunately my search for electronic copies of the National Health Department Health Plan has been unsuccessful.
But I promise to put it on my blog for download as soon as I get it.
That is interesting. To be honest, this is the first I’ve heard of these two new drugs lumfantrine and halofantrine being talked about as “1st line treatment”, Jeez, I’m way back ah? Are these two arthemether based drugs?? I always thought that because of this chloroquine resistance the first line treatment was changed to Arthemeter/artesunate and I trust I am not alone as the use of arthemeter is quite pervasive throughout the country amongst healthworker as well as lay persons self treating themselve.
The Paediatrics for Doctors in PNG Handbook, argueable the most authoratative treatment guidline for children in PNG advocates the use of Arthemeter/Artesunate and fansidar for severe malaria and for simple malaria it still advocates chlorquine or camoquine coupled with fansider +/- primaquine as a gametocidal. There is no mention of the above two drugs lumfantrine and halofantrine for the treatment of malaria in children (This Book was last updated in 2003 – I wonder if this will change in light of the recent said changes in policy).
I wonder also what is the true extent of chloroquine resistance malaria in PNG, I have not come across any study that maps this throughout PNG. Also what is the extent of other common causes of fever that may present with similar symptoms. eg. dengue fever.
Health worker for a number of reason, including absence of diagnostic equipment or a lack of confidence in existing diagnosis method ie microscopy or rapid test kits, or pressure from patients, tend to treat anyone with a fever with antimalarial…
Prof. Hombhanje did some work on this some years back if you can remember. I think he did the work for his MD thesis. Combination treatment is now widely accepted as evidence show that two drugs is better than one for malaria treatment. Most of the studies have been done in asian countries and enough evidence now exists to warrant this change in treatment protocol. PNGIMR data also support this trend in PNG, albeit selected research sites.
Hi.. I’m interested on the new protocol for malaria treatment here. I hope you could have a copy so we’d be informed about it.
Will publish it here once I get the facts. Keep watching this blog.
I ám still waiting for a direction from an authoritive body on the issue of standard treatment regimen for malaria in PNG. There are countless ways of diseminating vital information as such to the to the medical fraternity. I am sure the health department had come with some standards already but that’s not been widely and effectively communicated. Hence there is still varying opionions and arguements on what constitutes the first line treatment, second line treatment and so fort among practioners.
On the same note, there is already a high turnover and on influx of international visitors of travellers in the country so I hope that our malaria policy makers will be vary of that. May be they should include a fourth line treatment plan for this group somewhere.
On the issue of
Its good government had came up with the new malaria treatment protocal… Is there any research done on the implications of this new malaria treatment protocal have to the people (patients) and the health care practitioners after implementing the new protocal.
I am desperately trying to get treatment for malaria relapse. Got malaria in Papua New Guinea some years ago and this is my second relapse. Drs here o not know how to treat it…want me to go into anchorage, 200 miles away, for blood work. I just need the meds now!
If you are having relapse of symptoms and have not been to other malaria endemic country since you had malaria while in PNG, I suspect you probably got m.ovale infection. A friend of mine had a hard time obtain anti-malarial drugs in New Zealand when he had malaria..not a commonly prescribed drug there so the pharmacy had to put in a special order. Hope you get diagnosed and treated soon.